Clinical Decision Support Should Be Open Source

Andy Oram | EMR & EHR | January 26, 2015

Clinical decision support is a long-standing occupant of the medical setting. It got in the door with electronic medical records, and has recently received a facelift under the term “evidence based medicine.” We are told that CDS or EBM is becoming fine-tuned and energized through powerful analytics that pick up the increasing number of patient and public health data sets out in the field. But how does the clinician know that the advice given for a treatment or test is well-founded?

Most experts reaffirm that the final word lies with the physician–that each patient is unique, and thus no canned set of rules can substitute for the care that the physician must give to a patient’s particular conditions (such as a compromised heart or a history of suicidal ideation) and the sustained attention that the physician must give to the effects of treatment. Still, when the industry gives a platform to futurists such as Vinod Khosla who suggest that CDS can become more reliable than a physician’s judgment, we have to start demanding a lot more reliability from the computer.

It’s worth stopping a moment to consider the various inputs to CDS. Traditionally, it was based on the results of randomized, double-blind clinical trials. But these have come under scrutiny in recent years for numerous failings: the questionable validity of extending the results found on selected test subjects to a broader population, problems reproducing results for as many as three quarters of the studies, and of course the bias among pharma companies and journals alike for studies showing positive impacts...